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An additively manufactured intraoral scan body for aiding complete-arch intraoral implant digital scans with guided integration of 3D virtual representation
Abstract and Figures
This article describes a polymeric additively manufactured intraoral scan body that facilitates a complete-arch intraoral implant digital scan and guides the superimposition procedures between the facial and digital scans comprising the patient’s 3D virtual representation. Furthermore, this novel intraoral scan body can be modified for the patient’s specific arch dimensions, enhancing patient comfort and facilitating digitizing.
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... 29 Additively manufactured intraoral scan bodies have been developed for virtual patient's data integration providing patients size customization and chairside manufacturing capabilities. 6,[30][31][32] The intraoral scan body is used as a common element to align intraoral and facial digital scans. 6,[30][31][32] Dental literature analyzing the accuracy of virtual patient's integration is scarce. ...
... 6,[30][31][32] The intraoral scan body is used as a common element to align intraoral and facial digital scans. 6,[30][31][32] Dental literature analyzing the accuracy of virtual patient's integration is scarce. 33 Revilla-León et al 33 evaluated, in a clinical study, the accuracy of the virtual patient integration obtained by the superimposition of facial and intraoral digital scans guided by 2 scan body systems compared with CBCT imaging. ...
... Furthermore, there are different intraoral scan body designs based on the patient's clinical condition namely dentate and completely edentulous arches. 6,[30][31][32] Each intraoral scan body design aims to ease the clinical data collection techniques. 6,[30][31][32] To the authors best knowledge, there is no published study that compares the influence of the intraoral scan body design on facial scanning accuracy or virtual patient representation; therefore, the intraoral scan body designs are based on the knowledge and clinical experience of the authors. ...
Additively manufactured intraoral scan bodies can be used to guide the alignment of a patient's digital file information, including facial and intraoral digital scans both with and without a cone beam computed tomography scan, and to obtain a 3D virtual patient's representation. The present manuscript reviews the different intraoral scan body designs, procedures involved in additive manufacturing, clinical protocols for fabricating an additively manufactured scan body, performing a patient's digital data collection, and completing the alignment techniques.
... A previous technique has described an additively manufactured scan body to aid a complete-arch intraoral implant digital scan and guide the superimposition procedures between the facial and digital scans comprising the patient's 3D virtual representation. 8 However, for edentulous patients, the scan body design, clinical procedure, and superimposition methods needs to be altered for developing the clinical intervention. ...
... 20 A previous technique described an AM intraoral scan body for assisting a complete-arch intraoral implant digital scans and guiding the integration of 3D virtual representation. 8 In the present technique, a similar AM intraoral scan body was used; however, the AM intraoral scan body design was altered to facilitate the integration of the maxillary and mandibular occlusion rims. Furthermore, the clinical procedure and alignment protocol was modified for obtaining the virtual definitive casts and interocclusal registration and for guiding the integration of the virtual patient. ...
This report describes a technique to obtain a 3D virtual representation of a maxillary edentulous patient guided by an additively manufactured intraoral scan body. The intraoral scan body incorporated a custom tray and occlusion rim which facilitated the acquiring of a digital definitive cast, maxillary occlusion rim position, interocclusal registration, and guided the integration of the facial scans. The technique simplified the design and manufacturing of the maxillary overdenture.
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... This has enabled the use of the virtual patient not only for surgical planning but also for subsequent design and fabrication of the final implant restoration. 2,3 Virtual facebow techniques for virtual articulator (VA) mounting of edentulous casts with multiple implants are generally based on cone beam computed tomography (CBCT) imaging, 4,5 surgical templates, 5,6 existing complete denture, 7 provisional fixed implant-supported prosthesis, 4 occlusal rim, 8 or prefabricated scan appliance, 9 but require additional x-ray exam, clinical visits and costs from the patient. Nuytens et al. 10 demonstrated that a complete-arch intraoral implant scan with modified implant scan bodies (ISBs) and occlusal pillars can be superimposed on a three-dimensional (3D) virtual patient. ...
This clinical report introduces a novel clinical technique to create a 3D virtual patient for transferring the edentulous maxillary arch position with maxillomandibular relationship by using a facial scan device and an intraoral scanner and omitting CBCT imaging.
... However, the restricted clinical data does not support a systematic recommendation for selecting an implant scan body design. Furthermore, there may be no implant scan body design that optimally performs for all the different IOSs available.Additional variables that should also be considered include implant scan body manufacturing tolerance,66 implant scan body position distortion caused by tightening torque,60,67 and one-piece PEEK implant scan body wear due to multiple reuses.[68][69][70] Due to the limited available data, it is difficult to establish protocols based on the number of times that an implant scan body can be sterilized and reused. ...
Objectives:
To describe the factors related to patient intraoral conditions that impact the scanning accuracy of intraoral scanners (IOSs). A new classification for these influencing factors is proposed to facilitate dental professionals' decision-making and maximize the accuracy and reliability of intraoral digital scans.
Overview:
Variables related to intraoral conditions of the patient that can influence the scanning accuracy of IOSs include tooth type, presence of interdental spaces, arch width variations, palate characteristics, wetness, existing restorations, characteristics of the surface being digitized, edentulous areas, interimplant distance, position, angulation, and depth of existing implants, and implant scan body selection.
Conclusions:
The knowledge and understanding of the patient's intraoral conditions that can impact the scanning accuracy of IOSs is a fundamental element for maximizing the accuracy of IOSs.
Clinical significance:
The patient's intraoral conditions, or patient factors, can significantly impact intraoral scanning accuracy. Dental professionals must know and understand these influencing patient factors to maximize the accuracy of IOSs.
... They have been used for different clinical purposes, including obtaining virtual facebow records or performing facially driven digital diagnostic waxing procedures. [1][2][3][4][5][6][7][8][9][10][11] Intraoral digital scans are acquired by using intraoral scanners (IOSs), whereas facial digital scans can be acquired by using various facial scanning methods (FSMs). Although most aligner systems can be used to superimpose intraoral digital scans with facial digital scans acquired with any FSM, the accuracy of a 3DVP is greatly influenced by which FSM is used, being more accurate when using more accurate FSMs. ...
A technique for creating 3-dimensional virtual patients (3DVPs) by superimposing intraoral and facial digital scans guided with a novel aligner system is described. This aligner system supports design modifications to adapt to different facial scanning methods (FSMs) and reduce the impact of FSMs on the accuracy of 3DVPs. Two different designs of the aligner system are described: one for use with less-accurate FSMs and another for use with more-accurate FSMs. These virtual designs are available for download and use.
Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.
Additive manufacturing (AM) technologies build physical three‐dimensional (3D) geometries by a consecutive layer‐by‐layer addition of material. AM technologies can also produce 3D structures that can actively change their properties under environmental influences. When using subtractive or additive fabricating methods or computer‐aided design (CAD) and computer‐aided manufacturing procedures, the manufacturing workflow of a dental device starts with its virtual design, normally obtained using a dental or non‐dental CAD software program. In dentistry, vat‐polymerization, material jetting technologies, and material extrusion have been frequently used to process polymers and fabricate dental devices, such as dental casts, custom trays, silicone indexes, positioning guides for custom abutments, tooth preparation guides, interim dental restorations, removable prostheses, occlusal devices, and surgical guides. Powder bed fusion technologies are the most frequent metal AM technology used to manufacture cobalt–chromium and titanium frameworks in restorative dentistry.
The aim of this study was to evaluate the trueness of 5 intraoral scanners (IOSs) for digital impression of simulated implant scan bodies in a partially edentulous model. A 3D printed partially edentulous mandible model made of Co-Cr with a total of 6 bilaterally positioned cylinders in the canine, second premolar, and second molar area served as the study model. Digital scans of the model were made with a reference scanner (steroSCAN neo) and 5 IOSs (CEREC Omnicam, CS3600, i500, iTero Element, and TRIOS 3) (n = 10). For each IOS’s dataset, the XYZ coordinates of the cylinders were obtained from the reference point and the deviations from the reference scanner were calculated using a 3D reverse engineering program (Rapidform). The trueness values were analyzed by Kruskal-Wallis test and Mann-Whitney post hoc test. Direction and amount of deviation differed among cylinder position and among IOSs. Regardless of the IOS type, the cylinders positioned on the left second molar, nearest to the scanning start point, showed the smallest deviation. The deviation generally increased further away from scanning start point towards the right second molar. TRIOS 3 and i500 outperformed the other IOSs for partially edentulous digital impression. The accuracy of the CEREC Omnicam, CS3600, and iTero Element were similar on the left side, but they showed more deviations on the right side of the arch when compared to the other IOSs. The accuracy of IOS is still an area that needs to be improved.
Purpose of Review
Computer-aided design (CAD) softwares minimize human designing errors, reduce time and cost, and serve as more powerful diagnostic and designing tools for treatment planning in restorative dentistry when compared with conventional diagnostic waxing techniques. The goal of this article was to review the features of the available dental and open-source CAD softwares for a facially driven digital diagnostic waxing elaboration.
Recent Findings
The literature review demonstrated that when digital technologies are selected, the fundamental concepts remain, but the protocol differs. When fabricating a facially driven diagnostic waxing, the digitized dentition obtained from either an intraoral scanner or digitized conventional stone cast can be merged with either two-dimensional (2D) photographs or three-dimensional (3D) extraoral facial scans of the patient at different positions. This superimposition procedure has been described in dental and open-source CAD softwares. Indeed, dental CAD softwares offer intuitive tools for dental professionals; however, the flexibility in creating virtual designs is more limited compared with open-source softwares.
Summary
Digital technologies serve as a more powerful diagnostic and design tool when compared with conventional procedures. The integration of different digital technologies has promoted the development of a 3D virtual patient, allowing clinicians and dental technicians to superimpose data on patients’ facial skeletons, extraoral soft tissue, and dentition. Both dental and open-source CAD softwares greatly improve the facially driven diagnostic waxing predictability because they incorporate the patient’s facial references.
Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have beensuccessfully integrated into the digital workflow to treat completely edentulous patients. However, the digital design and manufacturing technique of the baseplate and occlusion rims have not yetbeen developed into the digital workflow.
This article describes a novel digital workflow using extraoral digitizing procedures, open-source CAD software, and additive manufacturing technologies to obtain a 3D patient. This virtual patient can then be used to plan treatment for a completely edentulous patient, with which the maxillary baseplate and occlusion rims are digitally designed.
The workflow allows the digital determination of tooth exposure at rest, the dental midline, the location of the canines, and the determination of the occlusal plane related to the Camper plane. The digital determination of these parameters increases the predictability of the treatment, reducing laboratory and clinician time and costs.
Aim
This systematic review and meta‐analysis were conducted to assess and compare the accuracy of conventional and digital implant impressions. The review was registered on the PROSPERO register (registration number: CRD42016050730).
Material and Methods
A systematic literature search was conducted adhering to PRISMA guidelines to identify studies on implant impressions published between 2012 and 2017. Experimental and clinical studies at all levels of evidence published in peer‐reviewed journals were included, excluding expert opinions. Data extraction was performed along defined parameters for studied specimens, digital and conventional impression specifications and outcome assessment.
Results
Seventy‐nine studies were included for the systematic review, thereof 77 experimental studies, one RCT and one retrospective study. The study setting was in vitro for most of the included studies (75 studies) and in vivo for four studies. Accuracy of conventional impressions was examined in 59 studies, whereas digital impressions were examined in 11 studies. Nine studies compared the accuracy of conventional and digital implant impressions. Reported measurements for the accuracy include the following: (a) linear and angular deviations between reference models and test models fabricated with each impression technique; (b) three‐dimensional deviations between impression posts and scan bodies respectively; and (c) fit of implant‐supported frameworks, assessed by measuring marginal discrepancy along implant abutments.) Meta‐analysis was performed of 62 studies. The results of conventional and digital implant impressions exhibited high values for heterogeneity.
Conclusions
The available data for accuracy of digital and conventional implant impressions have a low evidence level and do not include sufficient data on in vivo application to derive clinical recommendations.
The development of technologies including intraoral scanners, dental software for digital restoration design, and additive manufacturing has improved the digital workflow of restorative treatment. The present article describes a digital workflow with intraoral scanning, computer-aided design (CAD) software, and subtractive and additive manufacturing procedures for a patient receiving lithium disilicate laminate veneers.
Statement of problem:
The accuracy of the virtual images used in digital dentistry is essential to the success of oral rehabilitation.
Purpose:
The purpose of this systematic review was to estimate the mean accuracy of digital technologies used to scan facial, skeletal, and intraoral tissues.
Material and methods:
A search strategy was applied in 4 databases and in the non-peer-reviewed literature from April through June 2017 and was updated in July 2017. Studies evaluating the dimensional accuracy of 3-dimensional images acquired by the scanning of hard and soft tissues were included.
Results:
A total of 2093 studies were identified by the search strategy, of which 183 were initially screened for full-text reading and 34 were considered eligible for this review. The scanning of facial tissues showed deviation values ranging between 140 and 1330 μm, whereas the 3D reconstruction of the jaw bone ranged between 106 and 760 μm. The scanning of a dentate arch by intraoral and laboratorial scanners varied from 17 μm to 378 μm. For edentulous arches, the scanners showed a trueness ranging between 44.1 and 591 μm and between 19.32 and 112 μm for dental implant digital scanning.
Conclusions:
The current digital technologies are reported to be accurate for specific applications. However, the scanning of edentulous arches still represents a challenge.
Purpose:
The aim of this literature review was to provide an update on the current scientific knowledge in the field of 3D virtual patient science and to identify a possible easy, smart, and affordable method to combine different file formats obtained from different digital devices.
Methods:
Electronic searches of the Medline database was performed, up to May 2017, for articles dealing with the construction of a 3D virtual patient; the matching of data acquired with different digital devices (cone beam computed tomography, CBCT; face scanner, FS; intraoral scanner, IOS; and desktop scanner, DS) was considered. The inclusion of studies was based on the superimposition of at least 2 different digital sources.
Results:
Twenty-five studies were selected for subsequent examination. Only 3 studies analyzed the feasibility of superimposition of 3 different types of 3D data (CBCT + FS + IOS/DS). The most frequently used matching procedure was between CBCT and FS and CBCT and IOS/DS.
Conclusion:
The procedure of superimposition of data from CBCT, IOS, and FS is currently feasible and it is now possible to create a 3D "virtual patient" to better diagnose, plan the treatment, and communicate with patients.
Purpose:
To introduce a proof of concept technique and new integrated workflow to optimize the functional and esthetic outcome of the implant-supported restorations by means of a 3-dimensional (3D) facially-driven, digital assisted treatment plan.
Methods:
The Smiling Scan technique permits the creation of a virtual dental patient (VDP) showing a broad smile under static conditions. The patient is exposed to a cone beam computed tomography scan (CBCT), displaying a broad smile for the duration of the examination. Intraoral optical surface scanning (IOS) of the dental and soft tissue anatomy or extraoral optical surface scanning (EOS) of the study casts are achieved. The superimposition of the digital imaging and communications in medicine (DICOM) files with standard tessellation language (STL) files is performed using the virtual planning software program permitting the creation of a VDP.
Conclusions:
The smiling scan is an effective, easy to use, and low-cost technique to develop a more comprehensive and simplified facially driven computer-assisted treatment plan, allowing a prosthetically driven implant placement and the delivery of an immediate computer aided design (CAD) computer aided manufacturing (CAM) temporary fixed dental prostheses (CAD/CAM technology).
Background
The scanner does not measure the dental surface continually. Instead, it generates a point cloud, and these points are then joined to form the scanned object. This approximation will depend on the number of points generated (resolution), which can lead to low accuracy (trueness and precision) when fewer points are obtained. The purpose of this study is to determine the resolution of four intraoral digital imaging systems and to demonstrate the relationship between accuracy and resolution of the intraoral scanner in impressions of a complete dental arch.
Material and Methods
A master cast of the complete maxillary arch was prepared with different dental preparations. Using four digital impression systems, the cast was scanned inside of a black methacrylate box, obtaining a total of 40 digital impressions from each scanner. The resolution was obtained by dividing the number of points of each digital impression by the total surface area of the cast. Accuracy was evaluated using a three-dimensional measurement software, using the “best alignment” method of the casts with a highly faithful reference model obtained from an industrial scanner. Pearson correlation was used for statistical analysis of the data.
Results
Of the intraoral scanners, Omnicam is the system with the best resolution, with 79.82 points per mm2, followed by True Definition with 54.68 points per mm2, Trios with 41.21 points per mm2, and iTero with 34.20 points per mm2. However, the study found no relationship between resolution and accuracy of the study digital impression systems (P >0.05), except for Omnicam and its precision.
Conclusions
The resolution of the digital impression systems has no relationship with the accuracy they achieve in the impression of a complete dental arch. The study found that the Omnicam scanner is the system that obtains the best resolution, and that as the resolution increases, its precision increases.
Key words:Trueness, precision, accuracy, resolution, intraoral scanner, digital impression.
Statement of problem:
Limited evidence is available for the marginal and internal fit of fixed dental restorations fabricated with digital impressions compared with those fabricated with conventional impressions.
Purpose:
The purpose of this systematic review was to compare marginal and internal fit of fixed dental restorations fabricated with digital techniques to those fabricated using conventional impression techniques and to determine the effect of different variables on the accuracy of fit.
Material and methods:
Medline, Cochrane, and EMBASE databases were electronically searched and enriched by hand searches. Studies evaluating the fit of fixed dental restorations fabricated with digital and conventional impression techniques were identified. Pooled data were statistically analyzed, and factors affecting the accuracy of fit were identified, and their impact on accuracy of fit outcomes were assessed.
Results:
Dental restorations fabricated with digital impression techniques exhibited smaller marginal misfit than those fabricated with conventional impression techniques (P<.05). Both marginal and internal gaps were greater for stone die casts, whereas digital dies produced restorations with the smallest gaps (P<.05). When a digital impression was used to generate stereolithographic (SLA)/polyurethane dies, misfit values were intermediate. The fabrication technique, the type of restoration, and the impression material had no effect on misfit values (P>.05), whereas die and restoration materials were statistically associated (P<.05).
Conclusions:
Although conclusions were based mainly on in vitro studies, the digital impression technique provided better marginal and internal fit of fixed restorations than conventional techniques did.
Objectives:
The interest on intraoral scanners for digital impressions has been growing and new devices are continuously introduced on the market. It is timely to verify whether the several scanners proposed for full-arch digital impressions have been tested under clinical conditions for validity, repeatability, reproducibility, as well as for time efficiency, and patient acceptance.
Search methods:
An electronic search of the literature was conducted through PubMed, Scopus, Cochrane Library, Web of Science, and Embase, entering the query terms 'digital impression', 'intraoral digital impression', 'intraoral scanning', 'intraoral scanner', 'intraoral digital scanner', combined by the Boolean operator 'OR'. No language or time limitation was applied.
Selection criteria:
Only studies where digital full-arch impressions had been recorded intraorally were considered.
Results:
In only eight studies full-arch scans had been performed intraorally. Only four studies reported data on validity, repeatability, reproducibility of digital measurements and their samples were limited to subjects in complete permanent dentition. Only two intraoral scanners, Lava COS and iTero, were tested. Scanning times were measured in six studies and varied largely. Patients' acceptance of intraoral scanning was evaluated in four studies, but it was not specifically assessed for children.
Conclusions:
The scientific evidence so far collected on intraoral scanning is neither exhaustive, nor up-to-date. Data from full-arch scans performed in children should be collected. For a meaningful assessment of time efficiency, agreement should be reached on the procedural steps to be included in the computation of scanning time.
PURPOSE:
Digital developments have led to the opportunity to compose simulated patient models based on three-dimensional (3D) skeletal, facial, and dental imaging. The aim of this systematic review is to provide an update on the current knowledge, to report on the technical progress in the field of 3D virtual patient science, and to identify further research needs to accomplish clinical translation.
MATERIALS AND METHODS:
Searches were performed electronically (MEDLINE and OVID) and manually up to March 2014 for studies of 3D fusion imaging to create a virtual dental patient. Inclusion criteria were limited to human studies reporting on the technical protocol for superimposition of at least two different 3D data sets and medical field of interest.
RESULTS:
Of the 403 titles originally retrieved, 51 abstracts and, subsequently, 21 full texts were selected for review. Of the 21 full texts, 18 studies were included in the systematic review. Most of the investigations were designed as feasibility studies. Three different types of 3D data were identified for simulation: facial skeleton, extraoral soft tissue, and dentition. A total of 112 patients were investigated in the development of 3D virtual models.
CONCLUSION:
Superimposition of data on the facial skeleton, soft tissue, and/or dentition is a feasible technique to create a virtual patient under static conditions. Three-dimensional image fusion is of interest and importance in all fields of dental medicine. Future research should focus on the real-time replication of a human head, including dynamic movements, capturing data in a single step.
Purpose:
To compare the accuracy of digital and conventional impression techniques for partially and completely edentulous patients and to determine the effect of different variables on the accuracy outcomes.
Materials and methods:
An electronic and manual search was conducted to identify studies reporting on the accuracy of implant impressions. Pooled data were descriptively analyzed. Factors affecting the accuracy were identified, and their impact on accuracy outcomes was assessed.
Results:
The 76 studies that fulfilled the inclusion criteria featured 4 clinical studies and 72 in vitro studies. Studies were grouped according to edentulism; 41 reported on completely edentulous and 35 on partially edentulous patients. For completely edentulous patients, most in vitro studies and all three clinical studies demonstrated better accuracy with the splinted vs the nonsplinted technique (15 studies, splint; 1, nonsplint; 9, no difference). One clinical study and half of the in vitro studies reported better accuracy with the open-tray vs the closed-tray technique (10 studies, open-tray; 1, closed-tray; 10, no difference). For partially edentulous patients, one clinical study and most in vitro studies showed better accuracy with the splinted vs the nonsplinted technique (8 studies, splint; 2, nonsplint; 3, no difference). The majority of in vitro studies showed better accuracy with the open-tray vs the closed-tray technique (10 studies, open-tray; 1, closed-tray; 7, no difference), but the only clinical study reported no difference.
Conclusion:
The splinted impression technique is more accurate for both partially and completely edentulous patients. The open-tray technique is more accurate than the closed-tray for completely edentulous patients, but for partially edentulous patients there seems to be no difference. The impression material (polyether or polyvinylsiloxane) has no effect on the accuracy. The implant angulation affects the accuracy of implant impressions, while there are insufficient studies for the effect of implant connection type. Further accuracy studies are needed regarding digital implant impressions.
Purpose:
To quantify the impact of ambient lighting conditions on the accuracy (trueness and precision) of an intraoral scanner (IOS) when maxillary complete-arch and maxillary right quadrant digital scans were performed in a patient.
Material and methods:
One complete dentate patient was selected. A complete maxillary arch vinyl polysiloxane impression was obtained and poured using Type IV dental stone. The working cast was digitized using a laboratory scanner (E4 Dental Scanner; 3Shape) and the reference standard tessellation language (STL file) was obtained. Two groups were created based on the extension of the maxillary digital scans performed namely complete-arch (CA group) and right quadrant (RQ) groups. The CA and RQ digital scans of the patient were performed using an IOS (TRIOS 3; 3Shape) with 4 lighting conditions chair light (CL), 10 000 lux, room light (RL), 1003 lux, natural light (NL), 500 lux, and no light (ZL), 0 lux. Ten digital scans per group at each ambient light settings (CL, RL, NL, and ZL) were consecutively obtained (n = 10). The STLR file was used to analyze the discrepancy between the digitized working cast and digital scans using MeshLab software. Kruskal-Wallis, 1-way ANOVA, and pair-wise comparison were used to analyze the data.
Results:
Significant difference in the trueness and precision values were found across different lighting conditions where RL condition obtained the lowest absolute error compared with the other lighting conditions tested followed by CL, NL and ZL. On the CA group, RL condition also obtained the best accuracy values, CL and NL conditions performed closely and under ZL condition the mean error presented the highest values. On the RQ group, CL condition presented the lowest absolute error when compared with the other lighting conditions evaluated. A pair-wise multi-comparison showed no significant difference between NL and ZL conditions. In all groups, the standard deviation was higher than the mean errors from the control mesh, indicating that the relative precision was low.
Conclusions:
Light conditions significantly influenced on the scanning accuracy of the IOS evaluated. RL condition obtained the lowest absolute error value of the digital scans performed. The extension of the digital scan was a scanning accuracy influencing factor. The higher the extension of the digital scan performed, the lower the accuracy values obtained. Furthermore, ambient light scanning conditions influence differently depending on the extension of the digital scans made. This article is protected by copyright. All rights reserved.
Statement of problem. Digital scans have increasingly become an alternative to conventional impressions. Although previous studies have analyzed the accuracy of the available intraoral scanners (IOSs), the effect of the light scanning conditions on the accuracy of those IOS systems remains unclear.
Purpose. The purpose of this in vitro study was to measure the impact of lighting conditions on the accuracy (trueness and precision) of different IOSs.
Material and methods. A typodont was digitized by using an extraoral scanner (L2i; Imetric) to obtain a reference standard tessellation language (STL) file. Three IOSs were evaluateddiTero Element, CEREC Omnicam, and TRIOS 3dwith 4 lighting conditionsdchair light 10 000 lux, room light 1003 lux, natural light 500 lux, and no light 0 lux. Ten digital scans per group were recorded. The STL file was used as a reference to measure the discrepancy between the digitized typodont and digital scans by using the MeshLab software. The Kruskal-Wallis, 1-way ANOVA, and pairwise comparison were used to analyze the data.
Results. Significant differences for trueness and precision mean values were observed across different IOSs tested with the same lighting conditions and across different lighting conditions for a given IOS. In all groups, precision mean values were higher than their trueness values, indicating low relative precision.
Conclusions. Ambient lighting conditions influenced the accuracy (trueness and precision) of the IOSs tested. The recommended lighting conditions depend on the IOS selected. For iTero Element, chair and room light conditions resulted in better accuracy mean values. For CEREC Omnicam, zero light resulted in better accuracy, and for TRIOS 3, room light resulted in better accuracy.
Objectives:
The aim of this study was to evaluate the accuracy of complete-arch digital impressions for fabrication of an implant-supported prosthesis in the edentulous maxilla using an auxiliary geometry part.
Material and methods:
A replica of the upper jaw of an edentulous patient with four scannable impression copings was fabricated in stainless steel. This model was scanned with an industrial non-contact 3D structured blue light 3D scanner and the measurements of three reference distances were established as reference values. Subsequently, the model was scanned in two different scenarios (with or without an auxiliary geometry part put in place and fixed to the model) using three intraoral scanners. Measurements were taken with 3D inspection software and a digital impression of the complete arch was built with mesh-processing software by combining 2 STL files obtained with an intraoral scanner.
Results:
All measurements with the auxiliary geometry part gave significantly more accurate results (p<0.05). Trueness improved in the three reference distances, reaching values of 8 ±6µm at D12 reference distance, 20 ±11µm at D13 and 35 ±22µm at D14. Precision also improved significantly with the use of the auxiliary geometry part placed on the model (p<0.05). The best precision results at reference distances D13 and D14 were obtained with the True Definition scanner.
Conclusions:
The proposed methodology significantly improves the accuracy of complete-arch digital impressions in edentulous patients obtained in vitro, regardless of which scanner is used.
The present article describes a digital workflow for planning an esthetic treatment by using a facial and intraoral scanner, the dental and open-source software design of a facially generated diagnostic waxing, and additive manufactured (AM) clear silicone indices. A virtual design was created to fabricate a unique 3-piece AM index composed of flexible, clear silicone at the labial and lingual aspects and a rigid clear custom tray. The 3-piece AM clear indexes provided advantages compared with conventional procedures, including accurate reproduction of the digital diagnostic waxing, control of index thickness, various insertion paths of the silicone indices, flexibility of the indices, and online storage of the designs
Statement of problem:
The best-fit method is frequently used to evaluate the accuracy of different implant impression techniques. However, the method includes inherent superimposition errors, which may accumulate and become more exaggerated in complete-arch impressions.
Purpose:
The purpose of this in vitro study was to evaluate and compare the trueness and precision of conventional open-tray impressions and intraoral digital scans at the implant level in an edentulous maxillary model with 6 implant replicas without superimposition.
Material and methods:
A master model was fabricated using epoxy resin by duplicating a maxillary edentulous cast that had 6 implant replicas in the right first molar, right first premolar, right lateral incisor, left lateral incisor, left first premolar, and left first molar positions. The conventional open-tray, splinted-coping impression technique was used to fabricate 10 definitive casts (group CI). Intraoral digital scans were performed, after which scan bodies were connected to each implant replica to fabricate 10 digital models (group IOS). For the master model and group CI, a computerized coordinate-measuring machine was used to determine the 3D spatial orientation of the implant replicas. For group IOS, the scan bodies were converted to implant replicas using a digital library, and an inspection software program was used to measure the implant replicas. To compare the accuracies of different impression techniques, a 3D part coordinate system was set to compute the centroid and projection angles of each implant replica. The changes in the centroid coordinates (linear displacement: Δx, Δy, Δz, and ΔD; ΔD=Δx2+Δy2+Δz2) and projection angles onto XY and ZX planes (angular displacement: ΔθXY and ΔθZX) were statistically compared (α=.05).
Results:
Group CI gave more accurate trueness values than group IOS for overall Δx (P<.001), Δy (P =.029), Δz (P<.001), and ΔD (P<.001). Furthermore, group CI had more accurate precision values for Δx, Δy, and Δz. Group IOS exhibited a statistically greater angular displacement in the ZX plane (P=.002), but the difference was only 0.24 degrees. No differences were found between the 2 groups for the angular displacement in the XY plane (P=.529).
Conclusions:
Conventional open-tray impressions produced significantly smaller linear displacements than the digital scan obtained using an intraoral scanner at the implant level in a complete-arch model.
This article describes a technique for obtaining an accurate complete-arch digital scan for an edentulous patient. To achieve this, an auxiliary polymeric device that simulates a denture is designed, fabricated, and placed in the mouth. This device, having the geometry of a typical dental arch, facilitates the digitalization of the edentulous complete arch. This is because the change in radius of the curvature (change of geometry) enables the scanner to perform a more accurate alignment. Initially, the necessary location of the implants is acquired, and then the soft tissue is added. This technique can achieve accurate complete-arch digital scans. Distances between implants are closer to the gold standard when using this auxiliary geometry piece than those obtained without using it.
Harmony among the teeth, lips, and facial components is the goal of prosthodontic treatment, whether performed by conventional or digital workflow methods. This clinical report describes a facial approach to planning computer-guided surgery and immediate computer-aided designed and computer-aided manufactured (CAD-CAM) interim complete-arch fixed dental prostheses on immediately placed dental implants with a digital workflow. A single clinical appointment for data collection included dentofacial documentation with photographs and videos. On these photographs, facial reference lines were drawn to create a smile frame. This digital smile design and sagittal cephalometric analysis were merged with 3-dimensional scanned casts and a cone beam computed tomographic file in virtual planning software, thus guiding virtual waxing and implant positioning. Computer-guided implant surgery and CAD-CAM interim dental prostheses allowed esthetic and functional rehabilitation in a predictable manner and integrated with the patient’s face.
Application of computer assisted design/ computer assisted manufacturing (CAD/CAM) and digital workflow counterpart provides more innovative, high quality dental restorations which in turn lead to utilize different types of dental scanners in contemporary dental practice. This article aimed to provide the readers historical backgrounds of dental scanner and their various kinds; the benefits and pitfalls. A deep search was performed in available databases as well as the black areas of internet for trials keywords to find the data. Dental scanner used to measure the entire 3-dimensional (3D) of the external surface of a physical object either intraorally or extraorally from multiple directions. Implementation of the methods of 3D digitization in dental practice is a new methodology for dentistry which may revolutionize the routine techniques used commonly in dental practice. With this opportunity in hand easier, faster, accurate and more predictable dentistry is anticipated. © 2015, Journal of Chemical and Pharmaceutical Research. All rights reserved.
Purpose:
To conduct a systematic review to evaluate the evidence of possible benefits and accuracy of digital impression techniques vs. conventional impression techniques.
Materials and methods:
Reports of digital impression techniques versus conventional impression techniques were systematically searched for in the following databases: Cochrane Central Register of Controlled Trials, PubMed, and Web of Science. A combination of controlled vocabulary, free-text words, and well-defined inclusion and exclusion criteria guided the search.
Results:
Digital impression accuracy is at the same level as conventional impression methods in fabrication of crowns and short fixed dental prostheses (FDPs). For fabrication of implant-supported crowns and FDPs, digital impression accuracy is clinically acceptable. In full-arch impressions, conventional impression methods resulted in better accuracy compared to digital impressions.
Conclusions:
Digital impression techniques are a clinically acceptable alternative to conventional impression methods in fabrication of crowns and short FDPs. For fabrication of implant-supported crowns and FDPs, digital impression systems also result in clinically acceptable fit. Digital impression techniques are faster and can shorten the operation time. Based on this study, the conventional impression technique is still recommended for full-arch impressions.
Statement of problem:
In existing published reports, some studies indicate the superiority of digital impression systems in terms of the marginal accuracy of ceramic restorations, whereas others show that the conventional method provides restorations with better marginal fit than fully digital fabrication. Which impression method provides the lowest mean values for marginal adaptation is inconclusive. The findings from those studies cannot be easily generalized, and in vivo studies that could provide valid and meaningful information are limited in the existing publications.
Purpose:
The purpose of this study was to systematically review existing reports and evaluate the marginal fit of ceramic single-tooth restorations after either digital or conventional impression methods by combining the available evidence in a meta-analysis.
Material and methods:
The search strategy for this systematic review of the publications was based on a Population, Intervention, Comparison, and Outcome (PICO) framework. For the statistical analysis, the mean marginal fit values of each study were extracted and categorized according to the impression method to calculate the mean value, together with the 95% confidence intervals (CI) of each category, and to evaluate the impact of each impression method on the marginal adaptation by comparing digital and conventional techniques separately for in vitro and in vivo studies.
Results:
Twelve studies were included in the meta-analysis from the 63 identified records after database searching. For the in vitro studies, where ceramic restorations were fabricated after conventional impressions, the mean value of the marginal fit was 58.9 μm (95% CI: 41.1-76.7 μm), whereas after digital impressions, it was 63.3 μm (95% CI: 50.5-76.0 μm). In the in vivo studies, the mean marginal gap of the restorations after digital impressions was 56.1 μm (95% CI: 46.3-65.8 μm), whereas after conventional impressions, it was 79.2 μm (95% CI: 59.6-98.9 μm) CONCLUSION: No significant difference was observed regarding the marginal gap of single-unit ceramic restorations fabricated after digital or conventional impressions.
The aim of this Short Communication was to present a workflow for the superimposition of intraoral scan (IOS), cone-beam computed tomography (CBCT), and extraoral face scan (EOS) creating a 3D virtual dental patient.
As a proof-of-principle, full arch IOS, preoperative CBCT, and mimic EOS were taken and superimposed to a unique 3D data pool. The connecting link between the different files was to detect existing teeth as constant landmarks in all three data sets.
This novel application technique successfully demonstrated the feasibility of building a craniofacial virtual model by image fusion of IOS, CBCT, and EOS under 3D static conditions.
The presented application is the first approach that realized the fusion of intraoral and facial surfaces combined with skeletal anatomy imaging. This novel 3D superimposition technique allowed the simulation of treatment planning, the exploration of the patients' expectations, and the implementation as an effective communication tool. The next step will be the development of a real-time 4D virtual patient in motion.
Several noninvasive methods are used for 3-dimensional (3D) morphologic facial and dental analysis to aid practitioners during diagnosis and treatment planning. Integrating dental and facial noninvasive 3D reproduction could improve the efficacy of treatment management.
Dental virtual model and soft-tissue facial morphology were digitally integrated from 11 adults with a 3D stereophotogrammetric imaging system (Vectra, Canfield Scientific, Fairfield, NJ). The digital 3D coordinates of 3 facial landmarks (N, nasion; Ftr, frontotemporale right; Ftl, frontotemporale left) and 3 dental landmarks (I, interincisor; Pr, PI, tips of the mesiovestibular cusps of the right and left first permanent premolars) were then obtained by using Vectra's software. Additionally, the coordinates of the same 6 landmarks were digitized directly on each subject by using a 3D computerized electromagnetic digitizer (in vivo). Seven linear measurements were made between the occlusal plane (Pr-I-Pl) and the facial landmarks (Ftr-N-Ftl). The accuracy and reliability of the reconstruction were tested by in-vivo measurements and repeated acquisitions.
The greatest mean relative error of measurements was smaller than 1.2%. No significant differences in repeatable reproductions were found.
Integration of facial stereophotogrammetry acquisition and dental laser scan reproduction is possible with marginal error.
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Since 1915, various researchers have tried to make a 3-dimensional (3D) model of the complete face, with the dentition in the anatomically correct position. This was a difficult and time-consuming process. With the introduction of 3D digital imaging of the face and dental casts, researchers have regained interest in this topic. The purpose of this technical report is to present a feasibility study of the integration of a digital dental cast into a 3D facial picture.
For the integration, 3 digital data sets were constructed: a digital dental cast, a digital 3D photograph of the patient with the teeth visible, and a digital 3D photograph of the patient with the teeth in occlusion. By using a special iterated closest point algorithm, these 3 data sets were matched to place them in the correct anatomical position.
After matching the 3 data sets, we obtained a 3D digital model with the dental cast visible through the transparent picture of the patient's face. When the distance between the matched data sets was calculated, an average distance of 0.35 mm (SD, 0.32 mm) was shown. This means that matching the data sets is acceptable.
It seems technically possible to make a data set of a patient's face with the dentition positioned into this 3D picture. Future research needs to establish the value of this 3D fused data set of the face and the dentition in orthodontic diagnosis and treatment planning.
When making new dentures to replace old dentures for a patient, the final impression trays may be made quickly and easily with cold-curing acrylic resin tray material in a hydrocolloid mold.
Today's dentist does not just repair teeth to make them better for chewing. Increasingly, his or her work involves esthetics. With patients demanding more attractive teeth, dentists now must become more familiar with the formerly independent disciplines of orthodontics, periodontics, restorative dentistry, and maxillofacial surgery. This article provides a systematic method of evaluating dentofacial esthetics in a logical, interdisciplinary manner. In today's interdisciplinary dental world, treatment planning must begin with well-defined esthetic objectives. By beginning with esthetics, and taking into consideration the impact on function, structure, and biology, the clinician will be able to use the various disciplines in dentistry to deliver the highest level of dental care to each patient.
It can be difficult to achieve superior esthetics in implant-supported fixed partial dentures (FPDs). Zirconia ceramics with high flexural strength and esthetic can be treatment options for implant-supported FPDs. This article describes a simple and reliable method to fabricate a retrievable cemented implant-supported zirconia FPD.
Fundamentals of esthetics.
- Rufenacht C.R.
Rufenacht CR. Fundamentals of esthetics. Chicago: Quintessence; 1990. p.
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A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study.
- Hassan B.
- Gimenez Gonzalez B.
- Tahmaseb A.
- Greven M.
- Wismeijer D.
Hassan B, Gimenez Gonzalez B, Tahmaseb A, Greven M, Wismeijer D.
A digital approach integrating facial scanning in a CAD-CAM workflow for
complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study. J Prosthet Dent 2017;117:486-92.
Accuracy of digital implant impressions with intraoral scanners. A systematic review.
- Rutkūnas V.
- Gečiauskaitė A.
- Jegelevičius D.
- Vaitiekūnas M.
Kit de alineador. Argentina. Patent.
- Perez M.G.
An introduction to dental digitizers in dentistry. A systematic review
- Al-Jubuori
A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study
- Hassan
Accuracy of digital implant impressions with intraoral scanners. A systematic review
- Rutkūnas